{"id":2105,"date":"2022-06-05T23:51:09","date_gmt":"2022-06-05T20:51:09","guid":{"rendered":"https:\/\/endometriosisnet.gr\/does-endometriosis-get-worse-over-time\/"},"modified":"2026-01-07T14:53:34","modified_gmt":"2026-01-07T12:53:34","slug":"does-endometriosis-get-worse-over-time","status":"publish","type":"post","link":"https:\/\/endometriosisnet.gr\/en\/does-endometriosis-get-worse-over-time\/","title":{"rendered":"Does Endometriosis get worse over time?"},"content":{"rendered":"

It is not clear how the disease evolves with time. In its deep form (DIE), it is likely that endometriosis is a progressive disease (getting progressively worse over time1<\/sup>). This only makes sense, if we accept that large lesions must have developed over a period of time. The rate of progress is unlikely to be fast2<\/sup>, but may vary between patients. However, in mild cases, spontaneous resolution has been described3<\/sup>.<\/p>\r\n\r\n\r\n \r\n\r\n\r\n

Radical excision of endometriosis lesions reduces the risk of recurrence4,5<\/sup>. However, it does not fully eliminate the risk of recurrence6<\/sup>. This is likely secondary to a number of factors, such as the surgical technique7<\/sup>, patients age at the time of surgery4<\/sup>, as well as the severity of the disease8<\/sup>. What is more, non-visible lesions exist in up to 12% of cases9<\/sup>.<\/p>\r\n\r\n\r\n \r\n\r\n\r\n

It appears that amenorrhea (lack of periods) by means of post-operative hormonal contraception, reduces the risk of post-operative recurrence10<\/sup>. We, therefore, recommend the use of hormonal contraception post-operatively, except in cases where the woman wishes to get pregnant post-operatively. This sounds reasonable, if we accept that Sampson\u2019s theory of retrograde menstruation plays a role in the pathogenesis of endometriosis11<\/sup>.<\/p>\r\n\r\n\r\n \r\n\r\n\r\n

Endometriosis is a hormone-sensitive disease of the reproductive age- sensitive to hormones12<\/sup>. It, therefore, makes sense that menopause (with its associated rapid drop in the levels of hormones) causes an improvement in the symptoms13<\/sup>. Despite this being the general rule, cases of disease progression post-menopause have been described, usually as a result of hormone replacement therapy (HRT)14<\/sup>, and rarely in women with no previous history of endometriosis before the menopause15<\/sup>.<\/p>\r\n\r\n\r\n \r\n\r\n\r\n

References\u00a0:<\/u><\/strong><\/p>\r\n\r\n

    \r\n \t
  1. Koninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ. Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril. 1991 Apr;55(4):759-65.<\/li>\r\n\r\n \t
  2. Koninckx PR, Ussia A, Keckstein J, Wattiez A, Adamyan L. Epidemiology of subtle, typical, cystic, and deep endometriosis: a systematic review. Gynaecol Surg 2016;13:457\u201367.<\/li>\r\n\r\n \t
  3. Evers JL. Is adolescent endometriosis a progressive disease that needs to be diagnosed and treated? Hum Reprod 2013; 28:2023.<\/li>\r\n\r\n \t
  4. Busacca M, Chiaffarino F, Candiani M, Vignali M, Bertulessi C, Oggioni G, et al. Determinants of long-term clinically detected recurrence rates of deep, ovarian, and pelvic endometriosis. Am J Obstet Gynecol. 2006;195:426\u201332.<\/li>\r\n\r\n \t
  5. Vignali M, Bianchi S, Candiani M, Spadaccini G, Oggioni G, Busacca M. Surgical treatment of deep endometriosis and risk of recurrence. J Minim Invasive Gynecol. 2005.<\/li>\r\n\r\n \t
  6. Cea Soriano L., L\u00f3pez-Garcia E., Schulze-Rath R., Garcia Rodr\u00edguez L.A. Incidence, treatment and recurrence of endometriosis in a UK-based population analysis using data from The Health Improvement Network and the Hospital Episode Statistics database. Eur. J. Contracept. Reprod. Health Care. 2017;22:334\u2013343.<\/li>\r\n\r\n \t
  7. Fedele L, Bianchi S, Zanconato G, Bergamini V, Berlanda N, Carmignani L. Long-term follow-up after conservative surgery for bladder endometriosis. Fertil Steril. 2005.<\/li>\r\n\r\n \t
  8. Parazzini F, Bertulessi C, Pasini A, Rosati M, Di Stefano F, Shonauer S, et al. Determinants of short term recurrence rate of endometriosis. Eur J Obstet Gynecol Reprod Biol. 2005<\/li>\r\n\r\n \t
  9. Nisolle, M.; Paindaveine, B.; Bourdon, A.; Berli\u00e8re, M.; Casanas-Roux, F.; Donnez J, Histologic study of peritoneal endometriosis in infertile women. Fertil. Steril. 1990, 53, 984\u2013988.<\/li>\r\n\r\n \t
  10. Liu Y, Gong H, Gou J, Liu X, Li Z. Dienogest as a Maintenance Treatment for Endometriosis Following Surgery: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2021 Apr 7;8:652505.<\/li>\r\n\r\n \t
  11. Sampson JA. Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol 1927; 14:422\u201369.<\/li>\r\n\r\n \t
  12. Chantalat E, Valera MC, Vaysse C, Noirrit E, Rusidze M, Weyl A, Vergriete K, Buscail E, Lluel P, Fontaine C, Arnal JF, Lenfant F. Estrogen Receptors and Endometriosis. Int J Mol Sci. 2020 Apr 17;21(8):2815.<\/li>\r\n\r\n \t
  13. Cumiskey J., Whyte P., Kelehan P., Kelehan P., Gibbons D. A detailed morphologic and immunohistochemical comparison of pre- and postmenopausal endometriosis. J. Clin. Pathol. 2008;61:455\u2013459.<\/li>\r\n\r\n \t
  14. Dong-Su J., Tae-Hee K. Endometriosis in a Postmenopausal Woman on Hormonal Replacement Therapy. J. Menopausal Med. 2013;19:151\u2013153.<\/li>\r\n\r\n \t
  15. Benjamin M. Snyder Postmenopausal Deep Infiltrating Endometriosis of the Colon: Rare Location and Novel Medical Therapy. Hindawi Case Rep. Gastrointest. Med. 2018;2018:5.<\/li>\r\n<\/ol>","protected":false},"excerpt":{"rendered":"

    It is not clear how the disease evolves with time. In its deep form (DIE), it is likely that endometriosis is a progressive disease (getting progressively worse over time1). This only makes sense, if we accept that large lesions must have developed over a period of time. The rate of progress is unlikely to be […]<\/p>\n","protected":false},"author":1,"featured_media":2106,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[61],"tags":[70,73],"class_list":["post-2105","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-prognosis","tag-pathogenesis","tag-prognosis"],"_links":{"self":[{"href":"https:\/\/endometriosisnet.gr\/en\/wp-json\/wp\/v2\/posts\/2105","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/endometriosisnet.gr\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/endometriosisnet.gr\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/endometriosisnet.gr\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/endometriosisnet.gr\/en\/wp-json\/wp\/v2\/comments?post=2105"}],"version-history":[{"count":3,"href":"https:\/\/endometriosisnet.gr\/en\/wp-json\/wp\/v2\/posts\/2105\/revisions"}],"predecessor-version":[{"id":2112,"href":"https:\/\/endometriosisnet.gr\/en\/wp-json\/wp\/v2\/posts\/2105\/revisions\/2112"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/endometriosisnet.gr\/en\/wp-json\/wp\/v2\/media\/2106"}],"wp:attachment":[{"href":"https:\/\/endometriosisnet.gr\/en\/wp-json\/wp\/v2\/media?parent=2105"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/endometriosisnet.gr\/en\/wp-json\/wp\/v2\/categories?post=2105"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/endometriosisnet.gr\/en\/wp-json\/wp\/v2\/tags?post=2105"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}